Musculoskeletal Biology, Institute of Life Course and Medical Sciences, University of Liverpool.
Department of Rheumatology, Liverpool University Hospitals, Liverpool.
Rheumatology (Oxford). 2021 Dec 1;60(12):5734-5742. doi: 10.1093/rheumatology/keab242.
Depression and anxiety are associated with more severe disease in cross-sectional studies of axial spondyloarthritis (axSpA). We examined the association between baseline symptoms of depression or anxiety and response to TNF inhibitors (TNFi) in axSpA.
Biologic naïve participants from a national axSpA register completed the Hospital Anxiety and Depression Scale (HADS) before initiating TNFi. Symptoms of anxiety and depression were each categorized as moderate-severe (≥11), mild (8-10) and 'none' (≤7), and compared against change in disease indices [BASDAI and AS Disease Activity Score (ASDAS)] over time and time to treatment discontinuation using marginal structural models. Inverse-probability weights balanced baseline age, gender, BMI, deprivation, education and baseline values of respective disease indices.
Of the 742 participants (67% male, mean age 45 years), 176 (24%) had moderate-severe and 26% mild depression; 295 (40%) had moderate-severe and 23% mild anxiety. Baseline disease activity was higher in higher HADS symptom categories for both depression and anxiety. Participants with moderate-severe depression had significantly poorer response compared with those with 'none' throughout follow-up. At 6 months, the difference was approximately 2.2 BASDAI and 0.8 ASDAS units after balancing their baseline values. Equivalent comparisons for anxiety were 1.7 BASDAI and 0.7 ASDAS units. Treatment discontinuation was 1.59-fold higher (hazard ratio 95% CI: 1.12, 2.26) in participants with moderate-severe anxiety compared with 'none'.
Symptoms of depression and anxiety at TNFi initiation are associated with poorer treatment outcomes. Targeted interventions to optimize mental health have potential to substantially improve treatment response and persistence.
在轴性脊柱关节炎（axSpA）的横断面研究中，抑郁和焦虑与更严重的疾病相关。我们研究了 axSpA 患者基线时的抑郁或焦虑症状与 TNF 抑制剂（TNFi）反应之间的关系。
一项全国性 axSpA 登记处的生物初治参与者在开始使用 TNFi 前完成了医院焦虑和抑郁量表（HADS）。焦虑和抑郁症状分别被归类为中重度（≥11）、轻度（8-10）和“无”（≤7），并使用边缘结构模型比较随时间和治疗停药时间的疾病指标变化[BASDAI 和 AS 疾病活动评分（ASDAS）]。逆概率权重平衡了基线时的年龄、性别、BMI、贫困程度、教育程度和各自疾病指标的基线值。
在 742 名参与者中（67%为男性，平均年龄 45 岁），176 名（24%）有中重度抑郁；26%为轻度抑郁；295 名（40%）有中重度焦虑；23%为轻度焦虑。抑郁和焦虑的 HADS 症状类别越高，基线疾病活动度越高。与“无”相比，中重度抑郁患者在整个随访期间的反应明显较差。在平衡其基线值后，6 个月时的差异约为 2.2 BASDAI 和 0.8 ASDAS 单位。焦虑的等效比较为 1.7 BASDAI 和 0.7 ASDAS 单位。与“无”相比，中重度焦虑患者的治疗停药风险增加 1.59 倍（危险比 95%CI：1.12，2.26）。
TNFi 起始时的抑郁和焦虑症状与较差的治疗结局相关。针对心理健康的靶向干预措施有可能显著改善治疗反应和持续时间。
